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NPI Code Detail

MEDICARE: KRISTY JANIE ST ROSE

MEDICARE: KRISTY JANIE ST ROSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86300972NY

General Provider Information

NPI Number : 1710832225
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY JANIE ST ROSE
Provider Business Mailing Address
First Line : 760 MACON ST APT 4B
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-1361
Country : US
Telephone Number : 347-966-9015
Fax Number :
Provider Business Practice Location Address
First Line : 760 MACON ST APT 4B
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-1361
Country : US
Telephone Number : 347-966-9015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ KRISTY JANIE ST ROSE ” Practice Location

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